Clinical Analysis About Complication After Laser In Situ Keratomileusis In Treating Myopic Eyes

With the changing of the life style and environment in nowadays,Many factors cause myopic eyes,such as the computer and TV set use and the long time close distance work.A very important responsibility for refractive doctors is to find a safe,effective method to treat myopic eyes.Spectales and contact lens are effective,but not convenient.In the present,as the development of the technology,more and more operation method appeared,which are two types: lens operation and comea operation.The former include clear lensectomy and intraocular lens implantation.Even though this kind of operation is very effective to the high and ultra-high myopia,the lose of accommodation and the intraocular post-operation complication can not be neglect,such as retinal detachment and macular degeneration.All of these complications affect the clinical use of this kind of operation.The laser include radial keratotomy(RK), auto lamerllar keratoplasty(ALK),photorefractive keratectomy(PRK),and laser in situ keratomileusis(LASIK).RK apply to low and moderate myopia; ALK can treat high myopia,but it can't be applied widely because the acuity and the forecasting is fluctuate.PRK is applied to low and moderate myopia, and this kind of operation is effective,but there is haze in treating high myopia, and there is no settle method nowadays.LASIK has been one of the most important method in treating myopic eyes because of its no ache,quick resume, little tissue reaction and wide refractive range characters.With the increase of the operation amount,we found many post-operation complications which affect the safety and the effect of the operation.We should investigate the kind, cause,management and prevention of the post-operation complication and intervene in the key period to reduce and control the happen so that increase the effect of operation.We chose 502 patients including 1020 eyes that had LASIK operation in our hospital from the January in 2006 to the December in 2006,pre-operation myopia degree:range-1.75D～-15.00D D,average:-6.48±3.14D;astigmatism degree:range 0～-3.00D,average -1.44+-0.32D.We divided all the eyes into three groups on the base of the degree(spherical equivalent):Group A(low to moderate group):-1.75D～-6.00D,466 eyes;Group B(high myopia group): -6.25D～-10.00D,366 eyes;Group C(ultra-high myopia group):-10.50D～--15.00D,208 eyes.We observe the uncorrected visual acuity,changing rule of refractive state and four post-operation complications such as dry eye,diffuse lamellar keratitis,regression and the astigmatism after operation.We study the happen,the development and the effect of complication to the operation.The results show:1.The uncorrected visual acuity on twelve month after LASIK can reach up to the best corrected visual acuity preoperation.The rate is 97.42%,85.84%and 62.98%.Compare the three rate,there is statistic significance(P＜0.05).2.The refractive condition after LASIK is mine hyperopia in the early time,then emmetropia and with time went on,some patients change into myopia again.On the first week and 12 month after LASIK,compare the three groups respectively,there is statistic significance(P＜0.05).Then compare the three groups on the twelve month after LASIK, group C is higher than group B,and group B is higher than group A,this difference is obvious(P＜0.05).3.In the three groups,the rate of dry eye is highest in the first week and first month after LASIK operation,the average is 60%and 40%.With time went on,the rate reduce obviously.The average rate of dry eye in the twelve months after operation is 6.67%and the average of group A is 1.72%,group B is 8.67%and group C is 14.42%.Comparing the rate of three groups in the different time after operation,there is statistic significance(P＜0.05).4.43 eyes have had diffuse lamellar keratitis in early period after operation,the rate is 4.21%,in which 41 eyes are stageⅠand 2 eyes are stageⅡ,using hormones droppers frequently is very effective, stageⅠcured in 1～2 weeks,stageⅡcured in 1～2 months.5.It is about three months after LASIK operation when regression appeared and with time went on,there is no change for rate and degree of regression in group A,but increase in group B and group C.compare the rate and degree of regression in the three groups on 3 month,6 month and 12month after operation,group C is higher than group B,and group B is higher than group A,this difference has statistic significance(P＜0.05).6.The incidence rate of astigmatism is highest in the first week after LASIK operation,average 25.10%,and is stable 6 months after operation,average 3.33%;The astigmatism degree changed obviously in the former 3 months after operation and was stable after 3 months.Comparing the rate and degree in the three groups,group C was higher than group B,and group B was higher than group A,also had statistic significance(P＜0.05).This study indicates:1.LASIK is safe and effective in treating myopia,especially in the low to moderate myopia and high myopia,lesser in the ultra-high myopia.The main ingredient that affect the effect is regression and astigmatism.2.The refractive condition after LASIK is mine hyperopia in the early time, then emmetropia and with time went on,some patients change into myopia again. 3.The major complications after LASIK are dry eye,diffuse lamellar keratitis, regression and the astigmatism.(1)The rate of dry eye after LASIK is highest in the early time,then reduce gradually.This complication has no effect on the optical correction.(2)Diffuse lamellar keratitis is a kind of inflammation that is no infective and using hormone locally is very effective.(3)Regression appeared in the three month after LASIK and with time went on, low to moderate myopia has no change,but high and ultra-high myopia increase gradually.(4)The incidence of astigmatism after LASIK is highest in the early time.This rate is stable in the 3 month to 6 month after operation and the degree is correlate to the degree of pre-operation.In sum,the rate of the complication is different in different time.This has correlation with the refractive condition of pre-operation.Dealing with all kinds of complications effectively in time and reducing the harm as low as we can will be the important insurance for the success of operation.